Giant Cell Arteritis of the Breast

Abstract

Objective: To report a rare case of giant cell arteritis of the breast in a 56-year-old woman. Clinical Presentation and Intervention: The patient presented with tenderness in the upper outer quadrant of the left breast, in the absence of any constitutional symptoms. A diagnosis of giant cell arteritis was made only after surgical wedge excision of the affected breast quadrant. She returned 6 weeks later with tenderness in the upper inner medial quadrant of the same breast, with a raised erythrocyte sedimentation rate. She has since been referred to the rheumatologist for further management. Conclusion: The diagnosis of giant cell arteritis of the breast was made only after pathological examination of the excised breast tissue. This study focused attention on the need to be aware of systemic conditions that may present as localised lesions of the breast and to maintain a high index of clinical suspicion in order to adequately investigate them and perhaps avoid unnecessary radical surgical intervention such as mastectomy.

Giant Cell Arteritis of the Breast

“…In addition to rheumatic polymyalgia symptoms, such as mild fever, arthralgia, and myalgia, findings related to the breast should suggest GCA. However, a definitive diagnosis can be made by pathological examination (1,4). Microscopically, fragmentation of the elastic lamina of the vessel wall, giant cell infiltration, intimal proliferation, and narrowing of the lumen can be observed (1).…”

“…In most cases, when viewed retrospectively after pathologic diagnosis, the presence of systemic rheumatic symptoms draws attention. Therefore, a clinical suspicion and a further investigation are necessary to avoid the invasive radical approaches (4,5).…”

Giant cell arteritis of the breast: a case report with a review of literatures

“…Such discrimination can typically be achieved by performing an excisional biopsy. In our review of English medical literature, we encountered only 20 cases [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] of GCA, including the present case (Table 1). In all of the cases, the patients were elderly women (median age, 65 years; range, 52-79 years).…”

“…With regard to symptoms indicative of breast involvement, lumps due to arteritis were present in 80% of the cases (16 of 20 patients) [1-9, 13-16, 18], and redness and tenderness, in the absence of lumps, were noted in 10% (2 of 20 patients) [12,17]. Further, in 10% (2) of the cases [10,11], breast carcinoma and arteritis were unexpectedly identified in contiguous segments of the same specimens.…”

“…The characteristic clinical findings include tender unilateral or bilateral nodules of the breast, significant constitutional symptoms of anorexia, weight loss, myalgia, fever, and arthralgia. These symptoms should be treated rapidly, with or without prednisone therapy, and they can improve without the development of organ dysfunction [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. These typical features suggest that GCA of the breast is a unique syndrome [2].…”